Implementation of a Hospitalist‐Based Internal Medicine Ward System at a Community‐Based Teaching Hospital

1Inova Fairfax Hospital, Falls Church, VA
2Inova Fairfax Hospital, Falls Church, VA
3Inova Fairfax Hospital, Falls Church, VA

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 200


The literature consistently demonstrates that trainees are more satisfied when hospitalist teaching models are implemented. Before implementation of our ward system, house staff Teams cared for patients with different attendingsof record, and each attending of record supervised the care of patients on different resident teams. The teaching attending group consisted of hospitalists and private community physicians. Inpatient work/management rounds were conducted by the lead resident. Evaluations showed that trainees believed they needed to contact too many different attendings and lhat attending physicians wrole orders on Their paTienTs. Furthermore, house staff believed thai separate management and teaching rounds were redundant and that teaching rounds were frequently impractical and not patient‐based.


To implement a hospilalist‐based internal medicine ward system to improve trainee satisfaction.


In September 2008. we changed the structure of the internal medicine ward rotation. In our new ward system, each house staff team was paired with a hospitalist, who would serve as the teaching attending and the attending of record for all hospitalist patients on the service. The format of rounds was changed to combined management and teaching rounds. After implementation, trainees believed there were fewer attending‐written orders, less time spent on the phone with attending physicians, and fewer attending physicians that they needed to contact on a daily basis. Their preference for admitting with a hospitalist as the attending of record rather than a community physician became more marked. There was also a trend toward increased bedside teaching. There was no difference in internal medicine medical student shelf exam scores before and after implementation of a ward system.


We were able to implement an effective system utilizing hospilalisl faculty for our internal medicine ward rotation that met the interests of learners and educators while providing efficient care within the ACGME RRC‐IM program requirements. Although hospitalists received high marks, house staff may have preferred to admit to hospitalists because they were the ward attendings, not necessarily because they were better educators. A similar type of ward system may not be feasible or necessary for all institutions, and the format of the rotation should be tailored after a needs assessment and evaluation of the skills of the educators. Further study is required to determine effect of patient safety, length of stay, hospitalist job satisfactior and trainee knowledge, but prior studies in academic medical centers have demonstrated the benefit of hospitalist models on costs and outcomes.

Author Disclosure:

C. Venkatesan, none.

To cite this abstract:

Venkatesan C, Sheridan M, Kalwaney S. Implementation of a Hospitalist‐Based Internal Medicine Ward System at a Community‐Based Teaching Hospital. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 200. Journal of Hospital Medicine. 2010; 5 (suppl 1). Accessed April 4, 2020.

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